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Jit M, Cook AR. Informing Public Health Policies with Models for Disease Burden, Impact Evaluation, and Economic Evaluation. Annu Rev Public Health 2024; 45:133-150. [PMID: 37871140 DOI: 10.1146/annurev-publhealth-060222-025149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Conducting real-world public health experiments is often costly, time-consuming, and ethically challenging, so mathematical models have a long-standing history of being used to inform policy. Applications include estimating disease burden, performing economic evaluation of interventions, and responding to health emergencies such as pandemics. Models played a pivotal role during the COVID-19 pandemic, providing early detection of SARS-CoV-2's pandemic potential and informing subsequent public health measures. While models offer valuable policy insights, they often carry limitations, especially when they depend on assumptions and incomplete data. Striking a balance between accuracy and timely decision-making in rapidly evolving situations such as disease outbreaks is challenging. Modelers need to explore the extent to which their models deviate from representing the real world. The uncertainties inherent in models must be effectively communicated to policy makers and the public. As the field becomes increasingly influential, it needs to develop reporting standards that enable rigorous external scrutiny.
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Affiliation(s)
- Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom;
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Health System, Singapore
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Yang SL, Togawa K, Gilmour S, Leon ME, Soerjomataram I, Katanoda K. Projecting the impact of implementation of WHO MPOWER measures on smoking prevalence and mortality in Japan. Tob Control 2024; 33:295-301. [PMID: 36100264 DOI: 10.1136/tc-2022-057262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to quantify the long-term impact of implementing the WHO Framework Convention on Tobacco Control (FCTC) compliant tobacco control measures, MPOWER, on smoking prevalence and mortality in men and women aged ≥20 years in Japan. DESIGN A Stock-and-Flow simulation model was used to project smoking prevalence and mortality from 2018 to 2050 under eight different scenarios: (1) maintaining the 2018 status quo, (2) implementation of smoke-free policies, (3) tobacco use cessation programmes, (4-5) health warning about the dangers of tobacco (labels, mass media), (6) enforcement of tobacco advertising bans or (7) tobacco taxation at the highest recommended level and (8) all these interventions combined. RESULTS Under the status quo, the smoking prevalence in Japan will decrease from 29.6% to 15.5% in men and 8.3% to 4.7% in women by 2050. Full implementation of MPOWER will accelerate this trend, dropping the prevalence to 10.6% in men and 3.2% in women, and save nearly a quarter million deaths by 2050. This reduction implies that Japan will only attain the current national target of 12% overall smoking prevalence in 2033, 8 years earlier than it would with the status quo (in 2041), a significant delay from the national government's 2022 deadline. CONCLUSIONS To bring forward the elimination of tobacco smoking and substantially reduce smoking-related deaths, the government of Japan should fulfil its commitment to the FCTC and adopt stringent tobacco control measures delineated by MPOWER and beyond.
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Affiliation(s)
- Su Lan Yang
- Institute for Clinical Research, Centre for Clinical Epidemiology, National Institute of Health Malaysia, Selangor, Malaysia
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Kayo Togawa
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Stuart Gilmour
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Maria E Leon
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Kota Katanoda
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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Valiente R, Tunstall H, Kong AY, Wilson LB, Gillespie D, Angus C, Brennan A, Shortt NK, Pearce J. Geographical differences in the financial impacts of different forms of tobacco licence fees on small retailers in Scotland. Tob Control 2024:tc-2023-058342. [PMID: 38326025 DOI: 10.1136/tc-2023-058342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Retailer licencing fees are a promising avenue to regulate tobacco availability. However, they face strong opposition from retailers and the tobacco industry, who argue significant financial impacts. This study compares the impacts of different forms of tobacco licence schemes on retailers' profits in Scotland. METHODS We calculated gross profits from tobacco sales in 179 convenience stores across Scotland using 1 099 697 electronic point-of-sale records from 16 weeks between 2019 and 2022. We estimated different fees using universal, volumetric and separate urban/rural schemes. We identified the point at which 50% of retailers would no longer make a gross profit on tobacco sales for each scheme and modelled the financial impact of 10 incremental fee levels. The financial impact was assessed based on changes in retailers' tobacco gross profits. Differences by neighbourhood deprivation and urban/rural status were examined. RESULTS The gross profit from tobacco per convenience store averaged £15 859/year. Profits were 2.29 times higher in urban (vs rural) areas and 1.59 times higher in high-deprivation (vs low-deprivation) areas, attributable to higher sales volumes. Tobacco gross profit decreased proportionally with increasing fee levels. Universal and urban/rural fees had greater gross profit reductions in rural and/or less deprived areas, where profits were lower, compared with volumetric fees. CONCLUSION The introduction of tobacco licence fees offers a potential opportunity for reducing the availability of tobacco retailers. The likely impact of a tobacco licence fee is sensitive to the type of licence scheme implemented, the level at which fees are set and the retailers' location in relation to neighbourhood deprivation and rurality.
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Affiliation(s)
- Roberto Valiente
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Helena Tunstall
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Amanda Y Kong
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Luke B Wilson
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Duncan Gillespie
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Colin Angus
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Niamh K Shortt
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
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Kim H, Park S, Kang H, Kang N, Levy DT, Cho SI. Modeling the future of tobacco control: Using SimSmoke to explore the feasibility of the tobacco endgame in Korea. Tob Induc Dis 2023; 21:147. [PMID: 37954490 PMCID: PMC10632939 DOI: 10.18332/tid/174127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION We used a simulation model to assess the feasibility of reaching the tobacco endgame target (reducing the smoking prevalence to below 5% by 2050) and explored potential implementation strategies. METHODS The impact of strengthened tobacco-control policies on smoking prevalence was analyzed using Korea SimSmoke, a discrete-time Markov process. We considered the effects of various scenarios from 2023 and predictions were conducted until 2050. To confirm the stability of the results, deterministic and probabilistic sensitivity analyses were carried out by increasing and decreasing parameter estimates. RESULTS The implementation of tobacco-control policies in accordance with the WHO MPOWER (Μonitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco smoking; Warn of the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; Raise taxes on tobacco) measures were insufficient to achieve the tobacco endgame objective of 5% by 2050. The overall predicted smoking prevalence in 2050 is 4.7% if all policies are fully implemented in accordance with the FCTC guidelines together with a complete ban on the sale of cigarettes to people born after 2003 and annual 10% increases in price. Sensitivity analyses using the varying policy effect assumptions demonstrated the robustness of the simulation results. CONCLUSIONS For a substantive reduction in smoking prevalence, it is essential to strongly implement the MPOWER strategy. Beyond this foundational step, the eradication of smoking requires a paradigm shift in the perception of conventional tobacco-control policies, including a tobacco-free generation strategy and radical increases in the price of tobacco products.
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Affiliation(s)
- Hana Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Susan Park
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Heewon Kang
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Naeun Kang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, United States
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Rana K, Goel S, Prinja S. Effect of tobacco taxation on smoking prevalence and smoking-attributable deaths in India. Indian J Public Health 2023; 67:278-283. [PMID: 37459025 DOI: 10.4103/ijph.ijph_93_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background Higher taxes are the single most effective way to encourage tobacco users to quit tobacco use and prevent youth from initiation. Objectives The present study aims to estimate the effect of raising the tax on smoked tobacco products on its consumption and smoking-attributable deaths in India. Materials and Methods A mathematical model was developed which used the projected population of India, taxation rates on smoked tobacco products, smoking prevalence, and price elasticity of demand of cigarette and bidi from 2017 to 2025. Four scenarios of tax increment (0%, 25%, 50%, and 100%) on smoked tobacco products were created which were modeled to calculate smoking prevalence and smoking-attributable deaths due to respiratory diseases, heart diseases, stroke tuberculosis, and cancer in country till 2025. Results A relative decrease of 6.2% in the prevalence of smoking was observed between the existing tax rates and its increment to 100% over the last increment of 6%. Similarly, smoking-attributable deaths (SAD) decreased by 6.04% on increasing the tax rates to 100% of the existing taxation rates. There has been a steady increase in SAD in scenario 1 which decreases effectively in scenario 4, which in turn leads to the saving of around 33,000 lives due to tobacco-related diseases by 2025. Conclusion The consumption of cigarettes and bidis can be reduced by raising the price of these products. The model will help policymakers in deciding to fix the tax and ultimately the price of cigarettes and bidi to reduce its consumption and smoking-attributable mortality.
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Affiliation(s)
- Kirtan Rana
- Assistant Professor, Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sonu Goel
- Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rosen LJ, Galili T, Kott J, Rees V. Beyond "Safe and Effective": The urgent need for high-impact smoking cessation medications. Prev Med 2021; 150:106567. [PMID: 33957153 DOI: 10.1016/j.ypmed.2021.106567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
Smoking cessation medications (SCMs) are an evidence-based cornerstone of comprehensive tobacco control programs globally. However, the impact of SCMs on population smoking prevalence is controversial, with inconsistencies between randomized controlled trials (RCTs) and population-based observational studies. We estimated SCM impact on permanent cessation and population smoking prevalence by extrapolating efficacy estimates from meta-analyses of RCTs, using the standard population impact formula: efficacy*reach. We calculated the potential SCM impact under a range of assumptions for permanent cessation (20%,14%), behavioral support (yes/no), reach (40%-2%), and underlying smoking prevalence. Assuming behavioral support for all, depending on reach, 8%-0.3% of smokers are expected to quit permanently. Without behavioral support, permanent cessation is estimated to be 6.4%-0.2%. Assuming an underlying population smoking prevalence of 14%, (current U.S. prevalence), the maximum impact on population smoking prevalence is 1.12%. Impact on prevalence increases with increasing underlying country-specific levels of prevalence. With current U.S. levels of reach, behavioral support and smoking prevalence, we estimate that, based on a single course of treatment, 2.3% of smokers would quit permanently, contributing to a 0.3% decrease in population level smoking prevalence. Even under ideal conditions, the potential of current first-line SCMs to increase cessation in a substantial proportion of smokers, and reduce population smoking prevalence, is limited. In order to avert the predicted billion tobacco-caused deaths in this century, "safe and effective" medications are not sufficient: SCMs with high population impact are urgently needed. Policies to ensure the availability and accessibility of highly efficacious SCMs, with behavioral support, are crucial.
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Affiliation(s)
- Laura J Rosen
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel; Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. Chan School of Public Health, Boston, MA, USA.
| | - Tal Galili
- Department of Statistics and Operations Research, The Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Ramat-Aviv, Israel.
| | | | - Vaughan Rees
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. Chan School of Public Health, Boston, MA, USA
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Sánchez-Romero LM, Zavala-Arciniega L, Reynales-Shigematsu LM, de Miera-Juárez BS, Yuan Z, Li Y, Lau YK, Fleischer NL, Meza R, Thrasher JF, Levy DT. The Mexico SimSmoke tobacco control policy model: Development of a simulation model of daily and nondaily cigarette smoking. PLoS One 2021; 16:e0248215. [PMID: 34153063 PMCID: PMC8216521 DOI: 10.1371/journal.pone.0248215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Nondaily smoking has been on the rise, especially in Mexico. While Mexico has strengthened its tobacco control policies, their effects on nondaily smokers have gone largely unexamined. We developed a simulation model to estimate the impact of tobacco control policies on daily and nondaily smoking in Mexico. METHODS A previously validated Mexico SimSmoke model that estimated overall trends in smoking prevalence from 2002 through 2013 was extended to 2018 and adapted to distinguish daily and nondaily smoking prevalence. The model was then validated using data from Mexican surveys through 2016. To gauge the potential effects of policies, we compared the trends in smoking under current policies with trends from policies kept at their 2002 levels. RESULTS Between 2002 and 2016, Mexico SimSmoke underestimated the reduction in male and female daily smoking rates. For nondaily smoking, SimSmoke predicted a decline among both males and females, while survey rates showed increasing rates in both genders, primarily among ages 15-44. Of the total reduction in smoking rates predicted by the model by 2018, tax policies account for more than 55%, followed by health warnings, cessation treatment, smoke-free air laws, and tobacco control spending. CONCLUSIONS Although Mexico SimSmoke did not successfully explain trends in daily and nondaily smoking, it helps to identify gaps in surveillance and policy evaluation for nondaily smokers. Future research should consider appropriate measures of nondaily smoking prevalence, trajectories between daily and nondaily smoking, and the separate impact of tobacco control policies on each group.
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Affiliation(s)
- Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Luis Zavala-Arciniega
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, México
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | | | | | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Yan Kwan Lau
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | - Nancy L. Fleischer
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School Public Health, Ann Arbor, Michigan, United States of America
| | - James F. Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, México
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
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Levy DT, Sánchez-Romero LM, Travis N, Yuan Z, Li Y, Skolnick S, Jeon J, Tam J, Meza R. US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4876. [PMID: 34063672 PMCID: PMC8124578 DOI: 10.3390/ijerph18094876] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
The public health impact of nicotine vaping products (NVPs) is subject to a complex set of uncertain transitions between NVP and cigarette use. Instead, we apply an indirect method to gauge the impact of NVP use on smoking prevalence and smoking-attributable deaths (SADs) using the well-established SimSmoke tobacco control policy simulation model. Upon validating the model before NVPs were more widely used, we project a No-NVP (i.e., in the absence of NVPs) while controlling for the impact of cigarette-oriented policies. The net impact of NVPs on smoking prevalence is inferred by comparing the projected No-NVP smoking trends to corresponding trends from two US national surveys. Using the TUS-CPS estimates for the period 2012-2018, we estimate that adult smoking prevalence declined in relative terms by 9.7% (95% CI: 7.5-11.7%) for males and 10.7% (95% CI: 9.1-13.0%) for females. Compared to NHIS, smoking prevalence declined by 10.7% (95% CI: 6.8-14.6%) for males and 11.3% (95% CI: 7.4-15.6%) for females. These impacts were confined mainly to ages 18-44. Vaping-related reductions in smoking prevalence were projected to avert nearly 0.4 million SADs between 2012 and 2052. Our analysis indicates that NVP use is associated with substantial reductions in US smoking prevalence among younger adults.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Sarah Skolnick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jamie Tam
- Department of Health Policy and Management, Yale University School of Public Health, Hartford, CT 06520, USA;
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
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Levy DT, Sánchez-Romero LM, Li Y, Yuan Z, Travis N, Jarvis MJ, Brown J, McNeill A. England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England. Addiction 2021; 116:1196-1211. [PMID: 32949419 PMCID: PMC9364758 DOI: 10.1111/add.15269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England. DESIGN Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths. SETTING England, 2000-2019. PARTICIPANTS Nationally representative sample of population. MEASUREMENTS England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies. FINDINGS Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results. CONCLUSIONS An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Martin J Jarvis
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Ann McNeill
- National Addiction Centre, King's College London, UK
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Kim S, Choi S, Kim J, Park S, Kim YT, Park O, Oh K. Trends in health behaviors over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey. Epidemiol Health 2021; 43:e2021026. [PMID: 33872483 PMCID: PMC8289472 DOI: 10.4178/epih.e2021026] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to examine the trends in health behaviors in Korean population using data from the Korea National Health and Nutrition Examination Survey (KNHANES). METHODS The subjects were 96,408 adults aged 19 years or older who participated in the first (1998) through seventh (2016-2018) KNHANES health interview. The prevalence of health behaviors (cigarette smoking, alcohol drinking, and physical activity) and annual percent change (APC) were estimated using SAS and the Joinpoint program. RESULTS The prevalence of current cigarette smoking in men decreased by 2.8%p (APC=-2.8, p<0.001) annually over the 20-year period, and the prevalence of exposure to secondhand smoke at home substantially decreased compared to 2005 (APC=-8.8, p<0.001). Compared to 2005, the prevalence of current alcohol drinking in women, but not men, increased (APC=2.0, p<0.001), and the prevalence of binge drinking decreased in men (APC=-0.7, p<0.001) and increased in women (APC=2.4, p<0.001). The prevalence of aerobic physical activity decreased from 2014 in both gendersd (p<0.001). The prevalence of healthy behaviors practice (non-smoking, alcohol abstinence, and aerobic physical activity) was down-trending (APC=-5.3, p<0.001), especially among women (APC=-6.4, p<0.001). CONCLUSIONS Over the past 20 years, smoking behaviors improved. However, drinking behavior was unchanged and physical activity indicators markedly decreased. More active programs are necessary for improving health behaviors, which are major risk factors linked to chronic diseases.
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Affiliation(s)
- Soyeon Kim
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Sunhye Choi
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jihee Kim
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Suyeon Park
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Young-Taek Kim
- Public Health Medical Service Office, Chungnam National University Hospital, Daejeon, Korea
| | - Ok Park
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Kyungwon Oh
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
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Tobacco Endgame Simulation Modelling: Assessing the Impact of Policy Changes on Smoking Prevalence in 2035. FORECASTING 2021. [DOI: 10.3390/forecast3020017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Smoking causes substantial amount of mortality and morbidity. This article presents the findings from simulation models that projected the impact of five potential Tobacco Endgame strategies on smoking prevalence in Ontario by 2035 and expected impact of smoking prevalence “less than 5 by 35” on tax revenue. We used Ontario SimSmoke simulation for modelling the expected impact of four strategies: plain packaging, free cessation services, decreasing the number of tobacco outlets, and increasing tobacco taxes. Separate models were used to project the impact of increasing the minimum age to legally purchase tobacco to 21 years on smoking prevalence and impact of price and tax increase to achieve “less than 5 by 35” on taxation revenue. The combined effect of four strategies in Ontario SimSmoke Model are expected to reduce smoking prevalence by 8.5% in 2035. Increasing tobacco taxes had the greatest independent predicted decrease in smoking prevalence (2.8%) followed by raised minimum age for legal purchase to 21 years (2.4%), decreasing tobacco outlets (1.5%), free cessation services (0.7%), and plain packaging (0.6%). Increasing tobacco excise tax and prices are projected to have minimal impact on taxation revenue, with a decrease from 1.5 billion to 1.2 billion annual tax receipts.
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Singh A, Wilson N, Blakely T. Simulating future public health benefits of tobacco control interventions: a systematic review of models. Tob Control 2020; 30:tobaccocontrol-2019-055425. [PMID: 32587112 DOI: 10.1136/tobaccocontrol-2019-055425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND To prioritise tobacco control interventions, simulating their health impacts is valuable. We undertook a systematic review of tobacco intervention simulation models to assess model structure and input variations that may render model outputs non-comparable. METHODS We applied a Medline search with keywords intersecting modelling and tobacco. Papers were limited to those modelling health outputs (eg, mortality, health-adjusted life years), and at least two of cancer, cardiovascular and respiratory diseases. Data were extracted for each simulation model with ≥3 arising papers, including: model type, untimed or with time steps and trends in business-as-usual (BAU) tobacco prevalence and epidemiology. RESULTS Of 1911 papers, 186 met the inclusion criteria, including 13 eligible simulation models. The SimSmoke model had the largest number of publications (n=46), followed by Benefits of Smoking Cessation on Outcomes (n=12) and Tobacco Policy Model (n=10). Two of 13 models only estimated deaths averted, 1 had no time steps, 5 had no future trends in BAU tobacco prevalence, 9 had no future trends in BAU disease epidemiology and 7 had no time lags from quitting tobacco to reversal of health harm. CONCLUSIONS Considerable heterogeneity exists in simulation models, making outputs substantively non-comparable between models. Ranking of interventions by one model may be valid. However, this may not be true if, for example, interventions that differentially affect age groups (eg, a tobacco-free generation policy vs increased cessation among adults) do not account for plausible future trends. Greater standardisation of model structures and outputs will allow comparison across models and countries, and for comparisons of the impact of tobacco control interventions with other preventive interventions.
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Affiliation(s)
- Ankur Singh
- Centre for Health Equity, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nick Wilson
- Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago, Weliington, New Zealand
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Heydari G. A decade after introducing MPOWER, trend analysis of implementation of the WHO FCTC in the Eastern Mediterranean Region. Lung India 2020; 37:120-125. [PMID: 32108595 PMCID: PMC7065548 DOI: 10.4103/lungindia.lungindia_388_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Perfect implementation of the six priority policies advocated by the MPOWER package is the most important challenge for member states (MS) to reach tobacco control goals. Methods: A validated checklist set according to the WHO Report on the Global Tobacco Epidemic was filled out five times based on biannual reports from 2011 to 2019 for 22 MS in the Eastern Mediterranean Region. It contained ten topics including smoking prevalence and seven elements of six MPOWER policies and compliances resulting with possible maximum score of 37. High score indicates better implementation. Results: The total score for the region increased from 416 in 2011 to 509 in 2019. Six countries (27% of the region) had more than 75% of total score, whereas 11 countries were between 50% and 75% and five countries had <50% of total score in 2019. In all five reports, Iran was ranked first in the region even in 2019, when it witnessed a 2 point decrease. Iran held the first place alongside with Pakistan and Saudi Arabia with 32 points. The highest score in the indicators was related to the monitoring, reaching from 35 in 2011 to 59 in 2019. The lowest score increase in the indicators was related to the Smoke-free Policy compliance and the prevalence of consumption, reaching from 18 to 20 and 44–48, respectively, between 2011 and 2019. Conclusions: Although several remarkable achievements have been made regarding tobacco control goals, many policy implementation challenges remain and require urgent action by member states in the Eastern Mediterranean region.
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Affiliation(s)
- Gholamreza Heydari
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kwon DS, Kim TH, Byun MK, Kim HJ, Lee HS, Park HJ. Positive Effects of the National Cigarette Price Increase Policy on Smoking Cessation in South Korea. Tuberc Respir Dis (Seoul) 2020; 83:71-80. [PMID: 31905434 PMCID: PMC6953490 DOI: 10.4046/trd.2019.0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/10/2019] [Accepted: 08/30/2019] [Indexed: 01/15/2023] Open
Abstract
Background In January 2015, South Korea's government raised the cigarette tax, and the retail price of cigarettes abruptly increased by 80% compared to the previous year. This research aimed to determine the effect of this increase on smoking cessation among South Korean smokers. Methods We analyzed data collected by the 2013–2015 South Korea National Health and Nutrition Examination Survey of 15,203 South Koreans over 19 years old using regression analysis. We examined the recent non-smoking period of nonsmoking people, prepared according to the survey, and analyzed the recent smoking cessation ratio. Results Among smokers, from 2013 to 2014, the smoking cessation rate was 7.2%, and it increased to 9.9% in 2015 after the increase in the cigarette tax. In 2015, the recent smoking cessation rate was higher among people over the age of 60 (odds ratio [OR], 2.67) compared to those between the ages of 40 and 49. The recent smoking cessation rate was higher among people with below elementary education (OR, 2.28) and above university education (OR, 1.94) compared to high school, higher for those with apartments (OR, 1.74) compared to general type residences, and higher among those with a household income in the low-middle quartile (Q2) (OR, 2.32) compared to the highest quartile (Q4). Conclusion This innovative policy including increase in cigarette prices affected smoking cessation, and its impact varied by sub-group of smokers in South Korea.
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Affiliation(s)
- Do Sun Kwon
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Tae Hee Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Min Kwang Byun
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hyung Jung Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea.
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Sun D, Cao M, Li H, He S, Chen W. Cancer burden and trends in China: A review and comparison with Japan and South Korea. Chin J Cancer Res 2020; 32:129-139. [PMID: 32410791 PMCID: PMC7219092 DOI: 10.21147/j.issn.1000-9604.2020.02.01] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective To summarize the cancer burden and trends in China, compare the differences among China, Japan, and South Korea and discuss possible causes of the disparities. Methods Incidence and mortality data were extracted from the online cancer database including the GLOBOCAN 2018 and the Global Burden of Disease Study 2017. Trend analysis was conducted using the join-point analysis, and annual percent changes were calculated. Results Cancers resulted in approximately 62.9 million disability-adjusted life years (DALYs) in China in 2017. Lung cancer had the greatest contribution, followed by liver cancer, stomach cancer, and esophageal cancer. The trajectory of progress in the reduction of liver and stomach cancers was observed in China. However, China still faced a heavy burden of lung cancer and a growing burden of cancers related to westernized lifestyle such as colorectal cancer, while Japan and South Korea have achieved reductions in colorectal cancer and lung cancer, respectively. Besides, China had a lower age-standardized cancer incidence rate but higher cancer mortality and DALY rates than Japan and South Korea. Conclusions China is in the cancer transition stage with a rising burden of colorectal, prostate, and breast cancers along with a heavy burden of lung and upper digestive tract cancers. Taking into consideration the effectiveness of screening and tobacco control in Japan and South Korea, improvement in the current tobacco control policy and cancer screening systems may contribute to cancer control in China.
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Affiliation(s)
- Dianqin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Maomao Cao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Siyi He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Sanna M, Gao W, Chiu YW, Chiou HY, Chen YH, Wen CP, Levy DT. Tobacco control within and beyond WHO MPOWER: outcomes from Taiwan SimSmoke. Tob Control 2020; 29:36-42. [PMID: 30397030 PMCID: PMC6952844 DOI: 10.1136/tobaccocontrol-2018-054544] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Adult smoking prevalence in Taiwan rapidly declined from 26.5% in 2005 to 20.0% in 2015. Nevertheless, future projections on smoking-attributable deaths and current per capita consumption do not paint an equally bright picture. METHODS We used SimSmoke, a tobacco control simulation model to assess the impact of tax increases and other policies by predicting past and projecting over future decades smoking rates and smoking-attributable mortality. RESULTS The model accurately depicts the decline in smoking prevalence observed in Taiwan from 2000 to 2015. Nonetheless, under the 'status quo' scenario, smoking-attributable mortality is projected to continue growing, peaking at 26 602 annual deaths in 2039 and cumulative deaths >1 million by 2044. By comparing projections with current policies with a counterfactual scenario based on the 2000 policy levels, SimSmoke estimates that tobacco control in Taiwan has been able to reduce smoking prevalence by 30% in 2015 with 450 000 fewer smoking-attributable deaths by 2060. Modified scenarios show that doubling the retail price of cigarettes and fully implementing the remaining MPOWER measures would avert approximately 45 000 lives by 2040 and 130 000 by 2060. CONCLUSIONS Tobacco will be a leading cause of death in Taiwan for the coming decades, showing yet again the long-term consequences of smoking on public health. The MPOWER package, even if adopted at the highest level with a large tax increase, is unlikely to reduce smoking prevalence to the endgame goal of 5% in the next five decades.
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Affiliation(s)
- Mattia Sanna
- Master’s Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Wayne Gao
- Master’s Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Ya-Wen Chiu
- Master’s Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chi-Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| | - David Theodore Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
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Chang Y, Kang HY, Lim D, Cho HJ, Khang YH. Long-term trends in smoking prevalence and its socioeconomic inequalities in Korea, 1992-2016. Int J Equity Health 2019; 18:148. [PMID: 31533732 PMCID: PMC6751588 DOI: 10.1186/s12939-019-1051-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate long-term trends in smoking prevalence and its socioeconomic inequalities in Korea. METHODS Data were collected from 10 rounds of the Social Survey of Statistics Korea between 1992 and 2016. A total of 524,866 men and women aged 19 or over were analyzed. Age-adjusted smoking prevalence was calculated according to three major socioeconomic position indicators: education, occupational class, and income. The prevalence difference, prevalence ratio, slope index of inequality (SII), and relative index of inequality (RII) were calculated to examine the magnitude of inequality in smoking. RESULTS Smoking prevalence among men decreased from 71.7% in 1992 to 39.7% in 2016, while smoking prevalence among women decreased from 6.5% in 1992 to 3.3% in 2016. Socioeconomic inequalities in smoking prevalence according to the three socioeconomic position indicators were found in both men and women throughout the study period. In general, absolute and relative socioeconomic inequalities in smoking, measured by prevalence difference and prevalence ratio for education and occupational class, widened during the study period among Korean men and women. In men, the SII for income increased from 7.6% in 1999 to 10.8% in 2016 and the RII for income also increased from 1.11 in 1999 to 1.31 in 2016. In women, the SII for income increased from 0.1% in 1999 to 2.4% in 2016 and the RII for income increased from 1.39 in 1999 to 2.25 in 2016. CONCLUSION Pro-rich socioeconomic inequalities in smoking prevalence were found in men and women. Socioeconomic inequalities in smoking have increased in parallel with the implementation of tobacco control policies. Tobacco control policies should be developed to decrease socioeconomic inequalities in cigarette use in Korea.
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Affiliation(s)
- Youngs Chang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Dohee Lim
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
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Ranabhat CL, Kim CB, Park MB, Jakovljevic M(M. Situation, Impacts, and Future Challenges of Tobacco Control Policies for Youth: An Explorative Systematic Policy Review. Front Pharmacol 2019; 10:981. [PMID: 31551784 PMCID: PMC6745506 DOI: 10.3389/fphar.2019.00981] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Tobacco use in youths is a major public health challenge globally, and approaches to the challenge have not been sufficiently addressed. The existing policies for tobacco control are not well specified by age. Objective: Our study aims to systematically investigate existing tobacco control policies, potential impacts, and national and international challenges to control tobacco use targeting the youth. Data sources: We used the statistics of the Global Youth Tobacco Survey (GYTS), studies, and approaches of tobacco control policies targeting youth. Considering country, continent, age, and significance, PubMed, Health Inter-Network Access to Research Initiative (HINARI), Scopus, the Cochrane Library, Google, and Google Scholar were searched. The related keywords were tobacco control, youth, smoking, smoking reduction policies, prevalence of tobacco use in youth, classification of tobacco control policies, incentives to prevent young people from using tobacco, WHO Framework Convention on Tobacco Control (FTCT), etc. The search strategy was by timeline, specific and popular policies, reliability, significance, and applicability. Results: We found 122 studies related to this topic. There were 25 studies focusing on situation, significance, and theoretical aspects of tobacco control policies associated with youth; 41 studies on national population polices and challenges; and 7 studies for global challenges to overcome the youth tobacco epidemic. All national policies have been guided by WHO-MPOWER strategies. Increases in tobacco tax, warning signs on packaging, restriction of tobacco product advertisements, national law to discourage young people, and peer-based approaches to quit tobacco are popular policies. Smuggling of tobacco products by youth and ignorance of smokeless tobacco control approach are major challenges. Limitation: Our study was flexible for the standard age of youth and we were not able to include all countries in the world and most of the studies focused on smoking control rather than all smokeless tobaccos. Conclusion: The policies of tobacco control adopted by many countries are based on the WHO Framework Convention on Tobacco Control but not necessarily focused on youth. Due to the physical and economic burden of tobacco consumption by youth, this is a high priority that needs to be addressed. Youth-focused creative policies are necessary, and more priority must be given to tobacco prevention in youth. Tobacco control should be a social, public health, and quality-of-life concern rather than a business and trade issue. Implication of key findings: There is limited research on how and in what ways tobacco control policies reach young people and their engagement with these policies from physical, physiological, and psychological aspects. Analysis of these aspects, popular polices practiced in different countries, and creative strategies support the need to review current practices and future ways to discourage youth from tobacco use.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Policy Research Institute, Kathmandu, Nepal
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
- Manmohan Memorial Institute of Health Science, Kathmandu, Nepal
- Department of Gerontology, Pai Chai University, Daejeon, South Korea
| | - Chun-Bae Kim
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Myung Bae Park
- Department of Gerontology, Pai Chai University, Daejeon, South Korea
| | - Mihajlo (Michael) Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Division of Health Economics, Lund University, Lund, Sweden
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Gunter R, Szeto E, Jeong SH, Suh S, Waters AJ. Cigarette Smoking in South Korea: A Narrative Review. Korean J Fam Med 2019; 41:3-13. [PMID: 31189304 PMCID: PMC6987030 DOI: 10.4082/kjfm.18.0015] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 09/10/2018] [Indexed: 12/17/2022] Open
Abstract
Although the prevalence of cigarette smoking has declined in Western countries over the past few decades, a comparable decline among males has not been observed in Asian countries, especially in South Korea, where approximately 40%–50% of men and 4%–8% of women have been identified as smokers, and there is a pressing need to understand the background of cigarette smoking in these populations. The present study is a narrative review of the research literature on cigarette smoking in South Korea. First, we describe the social, economic, and cultural factors that impact cigarette smoking in South Korea. The paper also reviews the available peer-reviewed literature comprising observational studies and interventional studies, including randomized controlled trials. The extant literature on smoking in Korean Americans is also reviewed. Cigarette smoking in South Korea has been relatively understudied, and this review identifies priority areas for future research, including the use of mobile interventions.
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Affiliation(s)
- Rebekah Gunter
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Edwin Szeto
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Se-Hoon Jeong
- School of Media & Communication, Korea University, Seoul, Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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International Approaches to Tobacco Prevention and Cessation Programming and Policy among Adolescents in India. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0185-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Levy DT, Yuan Z, Luo Y, Mays D. Seven years of progress in tobacco control: an evaluation of the effect of nations meeting the highest level MPOWER measures between 2007 and 2014. Tob Control 2018; 27:50-57. [PMID: 27956650 PMCID: PMC5966723 DOI: 10.1136/tobaccocontrol-2016-053381] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/07/2016] [Accepted: 11/16/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Since WHO released the package of six MPOWER measures to assist nations with implementing the WHO Framework Convention for Tobacco Control (FCTC), 88 countries adopted at least one highest level MPOWER measure. We estimated the subsequent reduction in smoking-related deaths from all new highest level measures adopted between 2007 and 2014. METHODS Policy effect sizes based on previously validated SimSmoke models were applied to the number of smokers in each nation to determine the reduction in the number of smokers from policy adoption. On the basis of research that half of all smokers die from smoking, we derived the smoking-attributable deaths (SADs) averted of those smokers alive today. FINDINGS In total, 88 countries adopted at least one highest level MPOWER policy between 2007 and 2014, resulting in almost 22 million fewer projected SADs. The largest number of future SADs averted was due to increased cigarette taxes (7.0 million), followed by comprehensive smoke-free laws (5.4 million), large graphic health warnings (4.1 million), comprehensive marketing bans (3.8 million) and comprehensive cessation interventions (1.5 million). CONCLUSIONS These findings demonstrate the immense public health impact of tobacco control policies adopted globally since the WHO-FCTC and highlight the importance of more countries adopting highest level MPOWER measures to reduce the global burden of tobacco use. Substantial additional progress could be made, especially if heavily populated nations with high smoking prevalence were to reach highest level MPOWER measures.
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Affiliation(s)
- David T Levy
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Zhe Yuan
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Yuying Luo
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Levy DT, Mays D, Yuan Z, Hammond D, Thrasher JF. Public health benefits from pictorial health warnings on US cigarette packs: a SimSmoke simulation. Tob Control 2017; 26:649-655. [PMID: 27807299 PMCID: PMC5966722 DOI: 10.1136/tobaccocontrol-2016-053087] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/01/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION While many countries have adopted prominent pictorial warning labels (PWLs) for cigarette packs, the USA still requires only small, text-only labels located on one side of the cigarette pack that have little effect on smoking-related outcomes. Tobacco industry litigation blocked implementation of a 2011 Food and Drug Administration's (FDA) rule requiring large PWLs. To inform FDA action on PWLs, this study provides research-based estimates of their public health impacts. METHODS Literature was reviewed to identify the impact of cigarette PWLs on smoking prevalence, cessation and initiation. Based on this analysis, the SimSmoke model was used to estimate the effect of requiring PWLs in the USA on smoking prevalence and, using standard attribution methods, on smoking-attributable deaths (SADs) and key maternal and child health outcomes. RESULTS Available research consistently shows a direct association between PWLs and increased cessation and reduced smoking initiation and prevalence. The SimSmoke model projects that PWLs would reduce smoking prevalence by 5% (2.5%-9%) relative to the status quo over the short term and by 10% (4%-19%) over the long term. Over the next 50 years, PWLs are projected to avert 652 800 (327 000-1 190 500) SADs, 46 600 (17 500-92 300) low-birth-weight cases, 73 600 (27 800-145 100) preterm births and 1000 (400-2000) cases of sudden infant death syndrome. CONCLUSIONS Requiring PWLs on all US cigarette packs would be appropriate for the protection of the public health, because it would substantially reduce smoking prevalence and thereby reduce SADs and the morbidity and medical costs associated with adverse smoking-attributable birth outcomes.
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Affiliation(s)
- David T Levy
- Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Darren Mays
- Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Zhe Yuan
- Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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Kang E, Lee JA, Cho HJ. Characteristics of hardcore smokers in South Korea from 2007 to 2013. BMC Public Health 2017; 17:521. [PMID: 28549442 PMCID: PMC5446685 DOI: 10.1186/s12889-017-4452-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background As the prevalence of smoking decreased in western countries, a significant proportion of smokers appeared to be particularly resistant to quitting- “hardcore” smokers. This study examines the characteristics of hardcore smokers in South Korea. Methods We used the data from 2007 to 2013 from the Korea National Health and Nutrition Examination Survey. Hardcore smoking was defined as (1) smoking >15 cigarettes per day, (2) having no plans of quitting, and (3) having made no attempts to quit. Multiple logistic regression analyses were used to investigate the association between various sociodemographic variables and hardcore smoking. Results The proportion of hardcore smokers among smokers did not change significantly from 23.1% in 2007 to 23.0% in 2013. None of the three characteristics of hardcore smokers for either gender showed a significant change from 2007 to 2013. Multiple logistic regression analysis showed that hardcore smokers were 1.64 times (95% confidence interval [CI], 1.28–2.11) greater among those aging 40–49 years than among those aging 19–29 years, and four times greater among men than women. Never-married smokers were less likely to be hardcore smokers than married ones (odds ratio 0.79; 95% CI, 0.66–0.96). Household income and education level did not have any significant association with the likelihood of a hardcore smoker. Conclusions Hardcore smoking was more prevalent among men, unmarried men and those aging 40–49 years.
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Affiliation(s)
- EunKyo Kang
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung A Lee
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Raña P, Pérez-Ríos M, Santiago-Pérez MI, Crujeiras RM. Impact of a comprehensive law on the prevalence of tobacco consumption in Spain: evaluation of different scenarios. Public Health 2016; 138:41-9. [PMID: 27076441 DOI: 10.1016/j.puhe.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 12/16/2015] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Since 2011, smoking legislation was hardened in Spain, banning tobacco consumption in all hospitality venues. Law 42/2010 was the first comprehensive tobacco control policy enacted in Spain. The aim of this paper is to evaluate the effect that this intervention has had in reducing the prevalence of tobacco consumption, setting up three scenarios on the basis of different theoretical levels of effect of the law. METHODS A predictive model based on Markov Chains was developed to distinguish the effect of tobacco control policies in different scenarios. STUDY DESIGN The model developed uses population, smoking rates and smoking characteristics from a non-transmissible disease surveillance system developed in Galicia (namely SICRI). RESULTS Results show that tobacco control policies hardly affect the predicted trend in a temporal frame of 10 years, with relative reduction in the predicted male smoking prevalence of 20.4% with no intervention, reaching a reduction of 26.1% under the maximum effect of the policies. CONCLUSIONS In the global population the effects of the law in the predicted prevalence have been barely perceived. For people under 25 years of age, interventions have had an important and positive effect, which proves that policies affecting this age group should be hardened.
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Affiliation(s)
- P Raña
- Department of Mathematics, University of A Coruña, Spain
| | - M Pérez-Ríos
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Spain.
| | - M I Santiago-Pérez
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain
| | - R M Crujeiras
- Department of Statistics and Operations Research, University of Santiago de Compostela, Spain
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Levy DT, Meza R, Zhang Y, Holford TR. Gauging the Effect of U.S. Tobacco Control Policies From 1965 Through 2014 Using SimSmoke. Am J Prev Med 2016; 50:535-542. [PMID: 26673484 PMCID: PMC4801780 DOI: 10.1016/j.amepre.2015.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The year 2014 marked the 50th Anniversary of the first Surgeon General's Report. This paper estimates the effect of tobacco control policies in the U.S. after the 1964 Report using the SimSmoke tobacco control simulation model. METHODS SimSmoke uses National Health Interview Survey data from 1965 through 2012 on smoking prevalence, initiation, and cessation rates, and incorporates policies implemented since 1965. The model projects smoking prevalence and smoking-attributable deaths (SADs) from 1965 through 2065 and is validated against National Health Interview Survey data. Counterfactual scenarios with policies constant since 1965 and with individual policies are estimated. Analysis was conducted in February 2014. RESULTS SimSmoke generally validated well during the time period from 1965 through 2012. As a result of all policies, smoking prevalence is estimated to have fallen by almost 55% by 2014, with a total of 2 million SADs averted from 1965 through 2014, increasing to 20.1 million SADs by 2065. The Fairness Doctrine is estimated to have reduced adult smoking prevalence by about 24% by 2014 and averted 10.4 million SADs by 2065, while price increases reduced smoking prevalence by 24% by 2014 and averted 7.3 million SADs by 2065. Smoke-free air laws, cessation treatment, and tobacco control spending individually reduced smoking rates by 3%-5.5% by 2014. CONCLUSIONS By 2014, SimSmoke predicts a 53% reduction in smoking rates and almost 2 million SADs averted due to polices implemented since the 1964 Surgeon General's Report, with most of the health benefit still to occur in future years.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia.
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Yian Zhang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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Feirman SP, Donaldson E, Glasser AM, Pearson JL, Niaura R, Rose SW, Abrams DB, Villanti AC. Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review. Nicotine Tob Res 2016; 18:229-42. [PMID: 25977409 DOI: 10.1093/ntr/ntv104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models. METHODS We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies. RESULTS The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies. CONCLUSIONS This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.
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Affiliation(s)
- Shari P Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elisabeth Donaldson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ray Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
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Fleischer NL, Thrasher JF, Reynales-Shigematsu LM, Cummings KM, Meza R, Zhang Y, Levy DT. Mexico SimSmoke: how changes in tobacco control policies would impact smoking prevalence and smoking attributable deaths in Mexico. Glob Public Health 2016; 12:830-845. [PMID: 26837721 DOI: 10.1080/17441692.2015.1123749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We examined the effect of tobacco control policies in Mexico on smoking prevalence and smoking-related deaths using the Mexico SimSmoke model. The model is based on the previously developed SimSmoke simulation model of tobacco control policy, and uses population size, smoking rates and tobacco control policy data for Mexico. It assesses, individually, and in combination, the effect of six tobacco control policies on smoking prevalence and smoking-related deaths. Policies included: cigarette excise taxes, smoke-free laws, anti-smoking public education campaigns, marketing restrictions, access to tobacco cessation treatments and enforcement against tobacco sales youth. The model estimates that, if Mexico were to adopt strong tobacco control policies compared to current policy levels, smoking prevalence could be reduced by 30% in the next decade and by 50% by 2053; an additional 470,000 smoking-related premature deaths could be averted over the next 40 years. The greatest impact on smoking and smoking-related deaths would be achieved by raising excise taxes on cigarettes from 55% to at least 70% of the retail price, followed by strong youth access enforcement and access to cessation treatments. Implementing tobacco control policies in Mexico could reduce smoking prevalence by 50%, and prevent 470,000 smoking-related deaths by 2053.
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Affiliation(s)
- Nancy L Fleischer
- a Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health , University of Michigan , Ann Arbor , MI , USA
| | - James F Thrasher
- b Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,c Department of Tobacco Research, Center for Population Health Research , National Institute of Public Health , Cuernavaca , Mexico
| | - Luz Myriam Reynales-Shigematsu
- c Department of Tobacco Research, Center for Population Health Research , National Institute of Public Health , Cuernavaca , Mexico
| | - K Michael Cummings
- d Department of Psychiatry & Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Rafael Meza
- e Department of Epidemiology , University of Michigan , Ann Arbor , MI , USA
| | - Yian Zhang
- f Department of Oncology , Georgetown University , Washington , DC , USA
| | - David T Levy
- g Lombardi Comprehensive Cancer Center , Georgetown University , Washington , DC , USA
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Lee S. What hinders implementation of the WHO FCTC Article 5.3? - The case of South Korea. Glob Public Health 2015; 11:1109-20. [PMID: 26708121 DOI: 10.1080/17441692.2015.1122074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aims of this study are to identify what hinders implementation of the WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 in Korea, and to provide suggestions for the implementation of Article 5.3. Official governmental documents on tobacco control were reviewed. We also searched news articles for data triangulation. There were three factors that hindered the implementation of Article 5.3 in Korea. Firstly, there has been legal conflict between two tobacco-related laws, one of which is designed to promote the tobacco industry. The other is designed to promote public health. Secondly, the government has had economic interests in the tobacco industry, and its lack of action to effectively regulate the tobacco industry's corporate social responsibility (CSR) practices has hindered the implementation of Article 5.3. Thirdly, the tobacco industry's lobby and active interference in the policy-making process has been a barrier. To fully implement Article 5.3, this study suggests: defusing legal conflict between tobacco-related laws; not considering tobacco industry as a stakeholder; regulating tobacco industry's CSR activities; raising awareness of tobacco industry interference; securing transparency between the government and tobacco industry; and establishing a core group or a committee under the government to implement Article 5.3.
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Affiliation(s)
- Sungkyu Lee
- a National Evidence-based Healthcare Collaborating Agency , Seoul , South Korea
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Irvin VL, Hofstetter CR, Nichols JF, Chambers CD, Usita PM, Norman GJ, Kang S, Hovell MF. Compliance with smoke-free policies in korean bars and restaurants in california: a descriptive analysis. Asian Pac J Cancer Prev 2015; 16:1083-9. [PMID: 25735336 DOI: 10.7314/apjcp.2015.16.3.1083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compliance with California's smoke-free restaurant and bar policies may be more a function of social contingencies and less a function of legal contingencies. The aims of this study were: 1) to report indications of compliance with smoke-free legislation in Korean bars and restaurants in California; 2) to examine the demographic, smoking status, and acculturation factors of who smoked indoors; and 3) to report social cues in opposition to smoking among a sample of Koreans in California. MATERIALS AND METHODS Data were collected by telephone surveys administered by bilingual interviewers between 2007-2009, and included California adults of Korean descent who visited a Korean bar or restaurant in a typical month (N=2,173, 55% female). RESULTS 1% of restaurant-going participants smoked inside while 7% observed someone else smoke inside a Korean restaurant. Some 23% of bar-going participants smoked inside and 65% observed someone else smoke inside a Korean bar. Presence of ashtrays was related to indoor smoking in bars and restaurants. Among participants who observed smoking, a higher percentage observed someone ask a smoker to stop (17.6%) or gesture to a smoker (27.0%) inside Korean restaurants (N=169) than inside Korean bars (n=141, 17.0% observed verbal cue and 22.7% observed gesture). Participants who smoked inside were significantly younger and more acculturated than participants who did not. Less acculturated participants were significantly more to likely to be told to stop smoking. CONCLUSIONS Ten years after implementation of ordinances, smoking appears to be common in Korean bars in California.
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Affiliation(s)
- Veronica L Irvin
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University , Corvallis, USA. E-mail :
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Levy D, Mohlman MK, Zhang Y. Estimating the Potential Impact of Tobacco Control Policies on Adverse Maternal and Child Health Outcomes in the United States Using the SimSmoke Tobacco Control Policy Simulation Model. Nicotine Tob Res 2015; 18:1240-9. [PMID: 26385929 DOI: 10.1093/ntr/ntv178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 08/08/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Numerous studies document the causal relationship between prenatal smoking and adverse maternal and child health (MCH) outcomes. Studies also reveal the impact that tobacco control policies have on prenatal smoking. The purpose of this study is to estimate the effect of tobacco control policies on prenatal smoking prevalence and adverse MCH outcomes. METHODS The US SimSmoke simulation model was extended to consider adverse MCH outcomes. The model estimates prenatal smoking prevalence and, applying standard attribution methods, uses estimates of MCH prevalence and relative smoking risks to estimate smoking-attributable MCH outcomes over time. The model then estimates the effect of tobacco control policies on adverse birth outcomes averted. RESULTS Different tobacco control policies have varying impacts on the number of smoking-attributable adverse MCH birth outcomes. Higher cigarette taxes and comprehensive marketing bans individually have the biggest impact with a 5% to 10% reduction across all outcomes for the period from 2015 to 2065. The policies with the lowest impact (2%-3% decrease) during this period are cessation treatment, health warnings, and complete smoke-free laws. Combinations of all policies with each tax level lead to 23% to 28% decreases across all outcomes. CONCLUSIONS Our findings demonstrate the substantial impact of strong tobacco control policies for preventing adverse MCH outcomes, including long-term health implications for children exposed to low birth weight and preterm birth. These benefits are often overlooked in discussions of tobacco control.
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Affiliation(s)
- David Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | - Yian Zhang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Levy D, Fergus C, Rudov L, McCormick-Ricket I, Carton T. Tobacco Policies in Louisiana: Recommendations for Future Tobacco Control Investment from SimSmoke, a Policy Simulation Model. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 17:199-207. [PMID: 26314867 DOI: 10.1007/s11121-015-0587-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the presence of tobacco control policies, Louisiana continues to experience a high smoking burden and elevated smoking-attributable deaths. The SimSmoke model provides projections of these health outcomes in the face of existing and expanded (simulated) tobacco control polices. The SimSmoke model utilizes population data, smoking rates, and various tobacco control policy measures from Louisiana to predict smoking prevalence and smoking-attributable deaths. The model begins in 1993 and estimates are projected through 2054. The model is validated against existing Louisiana smoking prevalence data. The most powerful individual policy measure for reducing smoking prevalence is cigarette excise tax. However, a comprehensive cessation treatment policy is predicted to save the most lives. A combination of tobacco control policies provides the greatest reduction in smoking prevalence and smoking-attributable deaths. The existing Louisiana excise tax ranks as one of the lowest in the country and the legislature is against further increases. Alternative policy measures aimed at lowering prevalence and attributable deaths are: cessation treatments, comprehensive smoke-free policies, and limiting youth access. These three policies have a substantial effect on smoking prevalence and attributable deaths and are likely to encounter more favor in the Louisiana legislature than increasing the state excise tax.
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Affiliation(s)
- David Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, Washington, DC, 20007, USA
| | - Cristin Fergus
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Lindsey Rudov
- Division of Evaluation and Research, Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, 70112, USA
| | - Iben McCormick-Ricket
- Division of Evaluation and Research, Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, 70112, USA.
| | - Thomas Carton
- Division of Evaluation and Research, Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, 70112, USA
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Levy DT, Lindblom EN, Fleischer NL, Thrasher J, Mohlman MK, Zhang Y, Monshouwer K, Nagelhout GE. Public Health Effects of Restricting Retail Tobacco Product Displays and Ads. TOB REGUL SCI 2015; 1:61-75. [PMID: 26191538 PMCID: PMC4503383 DOI: 10.18001/trs.1.1.7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the public health impact from restricting US retail point-of-sale (POS) tobacco product displays and advertising. METHODS Based on existing research, this paper estimates the effects on initiation and cessation rates from restricting POS tobacco product displays and ads in the US and uses the SimSmoke simulation model to project related smoking declines and health benefits. RESULTS New comprehensive POS restrictions are projected to reduce smoking prevalence by approximately 16% [range=3%-31%] relative to the status quo by 2065, preventing about 630,000 smoking-attributable deaths [range=108,000-1,225,000], 215,000 low birth weight births [range=33,000-421,000], 140,000 preterm births [range=22,000-271,000], and 1900 infant deaths from SIDSs [range=300-3800]. CONCLUSIONS Federal, state, or local action to restrict POS tobacco product displays and ads would contribute to a substantial reduction in smoking-attributed death and disease.
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Affiliation(s)
- David T Levy
- Professor, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Eric N Lindblom
- Georgetown University, Law Center, O'Neill Institute for National & Global Health Law
| | - Nancy L Fleischer
- University of South Carolina, Department of Epidemiology and Biostatistics, Education, and Behavior, Columbia, SC
| | - James Thrasher
- University of South Carolina, Department of Health Promotion, Education, and Behavior, Columbia, SC
| | - Mary Kate Mohlman
- Epidemiologist, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Yian Zhang
- Research Assistant, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Karin Monshouwer
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Gera E Nagelhout
- Maastricht University (CAPHRL), Department of Health Promotion, Maastricht, The Netherlands
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Vugrin ED, Rostron BL, Verzi SJ, Brodsky NS, Brown TJ, Choiniere CJ, Coleman BN, Paredes A, Apelberg BJ. Modeling the potential effects of new tobacco products and policies: a dynamic population model for multiple product use and harm. PLoS One 2015; 10:e0121008. [PMID: 25815840 PMCID: PMC4376806 DOI: 10.1371/journal.pone.0121008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. METHODS AND FINDINGS We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. CONCLUSION Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.
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Affiliation(s)
- Eric D. Vugrin
- Resilience and Regulatory Effects, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Brian L. Rostron
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Stephen J. Verzi
- Systems Research, Analysis and Applications, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Nancy S. Brodsky
- Resilience and Regulatory Effects, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Theresa J. Brown
- Policy and Decision Analytics, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Conrad J. Choiniere
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Blair N. Coleman
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Antonio Paredes
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Benjamin J. Apelberg
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
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Jain D, Jadav A, Rhoten K, Bassi A. The Enforcement of India's Tobacco Control Legislation in the State of Haryana: A Case Study. WORLD MEDICAL & HEALTH POLICY 2014. [DOI: 10.1002/wmh3.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Park EY, Lim MK, Yang W, Yun EH, Oh JK, Jeong BY, Hong SY, Lee DH, Tamplin S. Policy effects of secondhand smoke exposure in public places in the Republic of Korea: evidence from PM2.5 levels and air nicotine concentrations. Asian Pac J Cancer Prev 2014; 14:7725-30. [PMID: 24460359 DOI: 10.7314/apjcp.2013.14.12.7725] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate secondhand smoke (SHS) exposure inside selected public places to provide basic data for the development and promotion of smoke-free policies. METHODS Between March and May 2009, an SHS exposure survey was conducted. PM2.5 levels and air nicotine concentrations were measured in hospitals (n=5), government buildings (4), restaurants (10) and entertainment venues (10) in Seoul, Republic of Korea, using a common protocol. Field researchers completed an observational questionnaire to document evidence of active smoking (the smell of cigarette smoke, presence of cigarette butts and witnessing people smoking) and administered a questionnaire regarding building characteristics and smoking policy. RESULTS Indoor PM2.5 levels and air nicotine concentrations were relatively higher in monitoring sites where smoking is not prohibited by law. Entertainment venues had the highest values of PM2.5(μg/m3) and air nicotine concentration(μg/m3), which were 7.6 and 67.9 fold higher than those of hospitals, respectively, where the values were the lowest. When evidence of active smoking was present, the mean PM2.5 level was 104.9 μg/m3, i.e., more than 4-fold the level determined by the World Health Organization for 24-hr exposure (25 μg/m3). Mean indoor air nicotine concentration at monitoring sites with evidence of active smoking was 59-fold higher than at sites without this evidence (2.94 μg/m3 vs. 0.05 μg/m3). The results were similar at all specific monitoring sites except restaurants, where mean indoor PM2.5 levels did not differ at sites with and without active smoking evidence and indoor air nicotine concentrations were higher in sites without evidence of smoking. CONCLUSION Nicotine was detected in most of our monitoring sites, including those where smoking is prohibited by law, such as hospitals, demonstrating that enforcement and compliance with current smoke-free policies in Korea is not adequate to protect against SHS exposure.
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Affiliation(s)
- Eun Young Park
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea E-mail :
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Walton M. Applying complexity theory: a review to inform evaluation design. EVALUATION AND PROGRAM PLANNING 2014; 45:119-126. [PMID: 24780280 DOI: 10.1016/j.evalprogplan.2014.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 04/04/2014] [Accepted: 04/06/2014] [Indexed: 06/03/2023]
Abstract
Complexity theory has increasingly been discussed and applied within evaluation literature over the past decade. This article reviews the discussion and use of complexity theory within academic journal literature. The aim is to identify the issues to be considered when applying complexity theory to evaluation. Reviewing 46 articles, two groups of themes are identified. The first group considers implications of applying complexity theory concepts for defining evaluation purpose, scope and units of analysis. The second group of themes consider methodology and method. Results provide a starting point for a configuration of an evaluation approach consistent with complexity theory, whilst also identifying a number of design considerations to be resolved within evaluation planning.
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Affiliation(s)
- Mat Walton
- School of Health and Social Services, Massey University, New Zealand.
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Levy D, Rodríguez-Buño RL, Hu TW, Moran AE. The potential effects of tobacco control in China: projections from the China SimSmoke simulation model. BMJ 2014; 348:g1134. [PMID: 24550245 PMCID: PMC3928439 DOI: 10.1136/bmj.g1134] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To use a computer simulation model to project the potential impact in China of tobacco control measures on smoking, as recommended by the World Health Organization Framework Convention on Tobacco Control (FCTC), being fully implemented. DESIGN Modelling study. SETTING China. POPULATION Males and females aged 15-74 years. INTERVENTION Incremental impact of more complete implementation of WHO FCTC policies simulated using SimSmoke, a Markov computer simulation model of tobacco smoking prevalence, smoking attributable deaths, and the impact of tobacco control policies. Data on China's adult population, current and former smoking prevalence, initiation and cessation rates, and past policy levels were entered into SimSmoke in order to predict past smoking rates and to project future status quo rates. The model was validated by comparing predicted smoking prevalence with smoking prevalence measured in tobacco surveys from 1996-2010. MAIN OUTCOME MEASURES Projected future smoking prevalence and smoking attributable deaths from 2013-50. RESULTS Status quo tobacco policy simulations projected a decline in smoking prevalence from 51.3% in 2015 to 46.5% by 2050 in males and from 2.1% to 1.3% in females. Of the individual FCTC recommended tobacco control policies, increasing the tobacco excise tax to 75% of the retail price was projected to be the most effective, incrementally reducing current smoking compared with the status quo by 12.9% by 2050. Complete and simultaneous implementation of all FCTC policies was projected to incrementally reduce smoking by about 40% relative to the 2050 status quo levels and to prevent approximately 12.8 million smoking attributable deaths and 154 million life years lost by 2050. CONCLUSIONS Complete implementation of WHO FCTC recommended policies would prevent more than 12.8 million smoking attributable deaths in China by 2050. Implementation of FCTC policies would alleviate a substantial portion of the tobacco related health burden that threatens to slow China's extraordinary gains in life expectancy and prosperity.
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Affiliation(s)
- David Levy
- Lombardi Comprehensive Cancer Center, Population Science, Department of Oncology, Georgetown University, Washington, DC 20007, USA
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Shin SS, Wan X, Wang Q, Raymond HF, Liu H, Ding D, Yang G, Novotny TE. Perceived discrimination and smoking among rural-to-urban migrant women in China. J Immigr Minor Health 2013; 15:132-40. [PMID: 22389186 DOI: 10.1007/s10903-012-9599-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Smoking may be a coping mechanism for psychosocial stress caused by discrimination. We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios. Of the 1,696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31-2.23) and current smoking (PR, 2.52; 95% CI, 1.32-4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16-1.61) and current smoking (PR, 1.63; 95% CI, 1.28-2.06) among FSWs. Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.
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Affiliation(s)
- Sanghyuk S Shin
- Joint Doctoral Program in Public Health, San Diego State University/University of California, San Diego, San Diego, CA, USA.
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Levy DT, Huang AT, Currie LM, Clancy L. The benefits from complying with the framework convention on tobacco control: a SimSmoke analysis of 15 European nations. Health Policy Plan 2013; 29:1031-42. [PMID: 24262281 DOI: 10.1093/heapol/czt085] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This article compares the predicted impact of tobacco tax increases alone and as part of a comprehensive tobacco control strategy on smoking prevalence and smoking-attributable deaths (SADs) across 15 European countries. METHODS Country-specific population, smoking prevalence and policy data with modified parameter values have been applied to the previously validated SimSmoke model for 10 high-income and 5 middle-income European nations. The impact of past and potential future policies is modelled. RESULTS Models generally validated well across the 15 countries, and showed the impact of past policies. Without stronger future policies, 44 million lives would be lost due to smoking across the 15 study countries between 2011 and 2040, but effective policies could avert 7.7 million of those premature deaths. CONCLUSIONS Results suggest that past policies have been effective in reducing smoking rates, but there is also a strong potential for future policies consistent with the Framework Convention on Tobacco Control. When specific taxes are increased to 70% of retail price, strong smoke-free air laws, youth access laws and marketing restrictions are enforced, stronger health warnings are implemented, and cessation treatment and media campaigns are supported, smoking prevalence and SADs will fall substantially in European countries.
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Affiliation(s)
- David T Levy
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
| | - An-Tsun Huang
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
| | - Laura M Currie
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
| | - Luke Clancy
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
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Maslennikova GY, Oganov RG, Boytsov SA, Ross H, Huang AT, Near A, Kotov A, Berezhnova I, Levy DT. Russia SimSmoke: the long-term effects of tobacco control policies on smoking prevalence and smoking-attributable deaths in Russia. Tob Control 2013; 23:484-90. [PMID: 23853252 DOI: 10.1136/tobaccocontrol-2013-051011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Russia has high smoking rates and weak tobacco control policies. A simulation model is used to examine the effect of tobacco control policies on past and future smoking prevalence and premature mortality in Russia. METHODS The Russia model was developed using the SimSmoke tobacco control model previously developed for the USA and other nations. The model inputs population size, birth, death and smoking rates specific to Russia. It assesses, individually and in combination, the effect of seven types of policies consistent with the WHO Framework Convention on Tobacco Control (FCTC): taxes, smoke-free air, mass media campaign, advertising bans, warning labels, cessation treatment and youth access policies. Outcomes are smoking prevalence and the number of smoking-attributable deaths by age and gender from 2009 to 2055. RESULTS Increasing cigarette taxes to 70% of retail price, stronger smoke-free air laws, a high-intensity media campaign and comprehensive treatment policies are each potent policies to reduce smoking prevalence and smoking-attributable premature deaths in Russia. With the stronger set of policies, the model estimates that, relative to the status quo trend, smoking prevalence can be reduced by as much as 30% by 2020, with a 50% reduction projected by 2055. This translates into 2 684 994 male and 1 011 985 female premature deaths averted from 2015-2055. CONCLUSIONS SimSmoke results highlight the relative contribution of policies to reducing the tobacco health burden in Russia. Significant inroads to reducing smoking prevalence and premature mortality can be achieved through strengthening tobacco control policies in line with FCTC recommendations.
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Affiliation(s)
- Galina Ya Maslennikova
- National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russian Federation
| | - Rafael G Oganov
- National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russian Federation
| | - Sergey A Boytsov
- National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russian Federation
| | - Hana Ross
- American Cancer Society, Atlanta, Georgia, USA
| | - An-Tsun Huang
- Georgetown University, Washington, District of Columbia, USA
| | - Aimee Near
- Georgetown University, Washington, District of Columbia, USA
| | - Alexey Kotov
- International Union Against Tuberculosis and Lung Disease, Moscow, Russian Federation
| | - Irina Berezhnova
- International Union Against Tuberculosis and Lung Disease, Moscow, Russian Federation
| | - David T Levy
- Georgetown University, Washington, District of Columbia, USA
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Arora M, Mathur MR, Singh N. A framework to prevent and control tobacco among adolescents and children: introducing the IMPACT model. Indian J Pediatr 2013; 80 Suppl 1:S55-62. [PMID: 22592283 DOI: 10.1007/s12098-012-0768-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/19/2012] [Indexed: 11/25/2022]
Abstract
The objective of this paper is to provide a comprehensive evidence based model aimed at addressing multi-level risk factors influencing tobacco use among children and adolescents with multi-level policy and programmatic approaches in India. Evidences around effectiveness of policy and program interventions from developed and developing countries were reviewed using Pubmed, Scopus, Google Scholar and Ovid databases. This evidence was then categorized under three broad approaches: Policy level approaches (increased taxation on tobacco products, smoke-free laws in public places and work places, effective health warnings, prohibiting tobacco advertising, promotions and sponsorships, and restricting access to minors); Community level approaches (school health programs, mass media campaigns, community based interventions, promoting tobacco free norms) and Individual level approaches (promoting cessation in various settings). This review of literature around determinants and interventions was organized into developing the IMPACT framework. The paper further presents a comparative analysis of tobacco control interventions in India vis a vis the proposed approaches. Mixed results were found for prevention and control efforts targeting youth. However, this article suggests a number of intervention strategies that have shown to be effective. Implementing these interventions in a coordinated way will provide potential synergies across interventions. Pediatricians have prominent role in advocating and implementing the IMPACT framework in countries aiming to prevent and control tobacco use among adolescents and children.
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Affiliation(s)
- Monika Arora
- Public Health Foundation of India (PHFI), PHD House, Sirifort Institutional Area, August Kranti Marg, New Delhi, 110 016, India.
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Levy DT, Blackman K, Currie LM, Mons U. Germany SimSmoke: the effect of tobacco control policies on future smoking prevalence and smoking-attributable deaths in Germany. Nicotine Tob Res 2013; 15:465-73. [PMID: 22855886 DOI: 10.1093/ntr/nts158] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Although Germany has recently implemented some tobacco control policies, there is considerable scope to strengthen policies consistent with the MPOWER guidelines. This article describes the development of a simulation model projecting the effect of future tobacco control policies in Germany on smoking prevalence and associated premature mortality. METHODS Germany SimSmoke-an adapted version of the SimSmoke simulation model of tobacco control policy-uses population, smoking rates, and policy data for Germany. It assesses, individually and in combination, the effect of seven types of policies: taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth access policies. RESULTS With a comprehensive set of policies, smoking prevalence within the first few years can be reduced by about 22.0% relative to the status quo and by 37.9% (40.5%) for males (females) in 30 years. By 2040, 39,548 deaths could be averted in that year alone. Without stronger policies, 700,000 additional smoking-attributable deaths (SADs) would occur in Germany over the next 30 years. CONCLUSIONS The model indicates that the consequences of inaction are considerable; without the implementation of a stronger set of policies, smoking prevalence rates will remain relatively stable, and SADs among women will continue to rise over a 30-year horizon. Significant inroads into reducing smoking prevalence and premature mortality can be achieved through strengthening tobacco control policies in line with MPOWER recommendations.
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Affiliation(s)
- David T Levy
- Pacific Institute for Research and Evaluation, Calverton, MD, USA
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Oh IH, Yoon SJ, Yoon TY, Choi JM, Choe BK, Kim EJ, Kim YA, Seo HY, Park YH. Health and economic burden of major cancers due to smoking in Korea. Asian Pac J Cancer Prev 2013; 13:1525-31. [PMID: 22799360 DOI: 10.7314/apjcp.2012.13.4.1525] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cigarette smoking is one of the most important public health concerns in Korea and worldwide. A number of studies have been conducted to measure the health and economic burden of smoking, but these did not reflect recent changes such as the decrease in smoking rate and the increase in the incidence of cancer. The purpose of this study was to provide up-to-date estimates of the health and economic burden of cancer caused by smoking and to compare the results with those of previous studies. Cancer-related burden was assessed with nationally representative data such as claims data from the National Health Insurance Corporation, and cause of death records from the National Statistical Office and the Korea Health Panel. We determined the smoking-attributable burden by multiplying the smoking-attributable fraction by the total burden. As a result, the burden of major cancers due to smoking was found to be substantial despite a recent sharp decrease in smoking by the Korean population. The total economic cost reaches $2,234.0 million in males and $870.0 million in females. Also, the health burden of cancers due to smoking is 2,038.9 disability adjusted life years (DALYs) per 100,000 individuals in men and 732.2 DALYs per 100,000 individuals in women. Among all cancers, cancers of the trachea, lungs and bronchus are the leading causes of health and economic burden. The huge burden caused by cancers linked to smoking makes it imperative that adequate policies to decrease the prevalence of smoking be developed, particularly considering the recent increase in smoking rate among women.
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Affiliation(s)
- In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
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Sussman S, Levy D, Lich KH, Cené CW, Kim MM, Rohrbach LA, Chaloupka FJ. Comparing effects of tobacco use prevention modalities: need for complex system models. Tob Induc Dis 2013; 11:2. [PMID: 23339410 PMCID: PMC3567972 DOI: 10.1186/1617-9625-11-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/17/2013] [Indexed: 11/29/2022] Open
Abstract
Many modalities of tobacco use prevention programming have been implemented including various policy regulations (tax increases, warning labels, limits on access, smoke-free policies, and restrictions on marketing), mass media programming, school-based classroom education, family involvement, and involvement of community agents (i.e., medical, social, political). The present manuscript provides a glance at these modalities to compare relative and combined impact of them on youth tobacco use. In a majority of trials, community-wide programming, which includes multiple modalities, has not been found to achieve impacts greater than single modality programming. Possibly, the most effective means of prevention involves a careful selection of program type combinations. Also, it is likely that a mechanism for coordinating maximally across program types (e.g., staging of programming) is needed to encourage a synergistic impact. Studying tobacco use prevention as a complex system is considered as a means to maximize effects from combinations of prevention types. Future studies will need to more systematically consider the role of combined programming.
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Affiliation(s)
- Steve Sussman
- Departments of Preventive Medicine and Psychology, University of Southern California, Soto Street Building 302A, 2001 N. Soto Street, Los Angeles, CA, 90033-9045, USA
| | - David Levy
- Department of Oncology, Georgetown University, Washington, DC, WA, USA
| | - Kristen Hassmiller Lich
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Crystal W Cené
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Mimi M Kim
- University of North Carolina, Cecil G. Sheps Center for Health Services Research and the NCTRaCS Institute, Chapel Hill, NC, USA
| | - Louise A Rohrbach
- Departments of Preventive Medicine and Psychology, University of Southern California, Soto Street Building 302A, 2001 N. Soto Street, Los Angeles, CA, 90033-9045, USA
| | - Frank J Chaloupka
- Institute for Health Research and Policy, Health Policy Center, University of Illinois, Chicago, IL, USA
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Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med 2012; 9:e1001336. [PMID: 23139643 PMCID: PMC3491001 DOI: 10.1371/journal.pmed.1001336] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brazil has reduced its smoking rate by about 50% in the last 20 y. During that time period, strong tobacco control policies were implemented. This paper estimates the effect of these stricter policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have. METHODS AND FINDINGS The model was developed using the SimSmoke tobacco control policy model. Using policy, population, and smoking data for Brazil, the model assesses the effect on premature deaths of cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs, and youth access restrictions. We estimate the effect of past policies relative to a counterfactual of policies kept to 1989 levels, and the effect of stricter future policies. Male and female smoking prevalence in Brazil have fallen by about half since 1989, which represents a 46% (lower and upper bounds: 28%-66%) relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Almost half of that 46% reduction is explained by price increases, 14% by smoke-free air laws, 14% by marketing restrictions, 8% by health warnings, 6% by mass media campaigns, and 10% by cessation treatment programs. As a result of the past policies, a total of almost 420,000 (260,000-715,000) deaths had been averted by 2010, increasing to almost 7 million (4.5 million-10.3 million) deaths projected by 2050. Comparing future implementation of a set of stricter policies to a scenario with 2010 policies held constant, smoking prevalence by 2050 could be reduced by another 39% (29%-54%), and 1.3 million (0.9 million-2.0 million) out of 9 million future premature deaths could be averted. CONCLUSIONS Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations. However, a set of stricter policies could further reduce smoking and save many additional lives. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- David Levy
- Population Sciences, Department of Oncology, Georgetown University, Washington DC, USA.
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Levy DT, Boyle RG, Abrams DB. The role of public policies in reducing smoking: the Minnesota SimSmoke tobacco policy model. Am J Prev Med 2012; 43:S179-86. [PMID: 23079215 PMCID: PMC4487773 DOI: 10.1016/j.amepre.2012.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/19/2012] [Accepted: 07/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Following the landmark lawsuit and settlement with the tobacco industry, Minnesota pursued the implementation of stricter tobacco control policies, including tax increases, mass media campaigns, smokefree air laws, and cessation treatment policies. Modeling is used to examine policy effects on smoking prevalence and smoking-attributable deaths. PURPOSE To estimate the effect of tobacco control policies in Minnesota on smoking prevalence and smoking-attributable deaths using the SimSmoke simulation model. METHODS Minnesota data starting in 1993 are applied to SimSmoke, a simulation model used to examine the effect of tobacco control policies over time on smoking initiation and cessation. Upon validating the model against smoking prevalence, SimSmoke is used to distinguish the effect of policies implemented since 1993 on smoking prevalence. Using standard attribution methods, SimSmoke also estimates deaths averted as a result of the policies. RESULTS SimSmoke predicts smoking prevalence accurately between 1993 and 2011. Since 1993, a relative reduction in smoking rates of 29% by 2011 and of 41% by 2041 can be attributed to tobacco control policies, mainly tax increases, smokefree air laws, media campaigns, and cessation treatment programs. Moreover, 48,000 smoking-attributable deaths will be averted by 2041. CONCLUSIONS Minnesota SimSmoke demonstrates that tobacco control policies, especially taxes, have substantially reduced smoking prevalence and smoking-attributable deaths. Taxes, smokefree air laws, mass media, cessation treatment policies, and youth-access enforcement contributed to the decline in prevalence and deaths averted, with the strongest component being taxes. With stronger policies, for example, increasing cigarette taxes to $4.00 per pack, Minnesota's smoking rate could be reduced by another 13%, and 7200 deaths could be averted by 2041.
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Affiliation(s)
- David T Levy
- Department of Oncology, Georgetown University, Washington, DC 20007, USA.
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Levy D, Gallus S, Blackman K, Carreras G, La Vecchia C, Gorini G. Italy SimSmoke: the effect of tobacco control policies on smoking prevalence and smoking attributable deaths in Italy. BMC Public Health 2012; 12:709. [PMID: 22931428 PMCID: PMC3490827 DOI: 10.1186/1471-2458-12-709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/02/2012] [Indexed: 11/16/2022] Open
Abstract
Background While Italy has implemented some tobacco control policies over the last few decades, which resulted in a decreased smoking prevalence, there is still considerable scope to strengthen tobacco control policies consistent with the World Health Organization (WHO) policy guidelines. The present study aims to evaluate the effect of past and project the effect of future tobacco control policies on smoking prevalence and associated premature mortality in Italy. Methods To assess, individually and in combination, the effect of seven types of policies, we used the SimSmoke simulation model of tobacco control policy. The model uses population, smoking rates and tobacco control policy data for Italy. Results Significant reductions of smoking prevalence and premature mortality can be achieved through tobacco price increases, high intensity media campaigns, comprehensive cessation treatment program, strong health warnings, stricter smoke-free air regulations and advertising bans, and youth access laws. With a comprehensive approach, the smoking prevalence can be decreased by as much as 12% soon after the policies are in place, increasing to a 30% reduction in the next twenty years and a 34% reduction by 30 years in 2040. Without effective tobacco control policies, a total of almost 300 thousand lives will be prematurely lost due to smoking by the year 2040. Conclusion Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps identify information gaps in surveillance and evaluation schemes that will promote the effectiveness of future tobacco control policy in Italy.
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Affiliation(s)
- David Levy
- Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, 19-20156, Milan, Italy
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Morrissey JP, Lich KH, Price RA, Mandelblatt J. Computational modeling and multilevel cancer control interventions. J Natl Cancer Inst Monogr 2012; 2012:56-66. [PMID: 22623597 DOI: 10.1093/jncimonographs/lgs014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This chapter presents an overview of computational modeling as a tool for multilevel cancer care and intervention research. Model-based analyses have been conducted at various "beneath the skin" or biological scales as well as at various "above the skin" or socioecological levels of cancer care delivery. We review the basic elements of computational modeling and illustrate its applications in four cancer control intervention areas: tobacco use, colorectal cancer screening, cervical cancer screening, and racial disparities in access to breast cancer care. Most of these models have examined cancer processes and outcomes at only one or two levels. We suggest ways these models can be expanded to consider interactions involving three or more levels. Looking forward, a number of methodological, structural, and communication barriers must be overcome to create useful computational models of multilevel cancer interventions and population health.
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Affiliation(s)
- Joseph P Morrissey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Rm 126, 725 Martin Luther King Jr Blvd, Chapel Hill, NC 27599-7590, USA.
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Levy DT, Blackman K, Currie LM, Levy J, Clancy L. SimSmokeFinn: how far can tobacco control policies move Finland toward tobacco-free 2040 goals? Scand J Public Health 2012; 40:544-52. [PMID: 22899560 DOI: 10.1177/1403494812456635] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Finland is the first country to stipulate in law that its aim is to end the use of tobacco products containing compounds that are toxic to humans and that create addiction. This paper describes the development of a simulation model examining the potential effect of tobacco control policies in Finland on smoking prevalence and associated future premature mortality. METHODS The model is developed using the SimSmoke simulation model of tobacco control policy, previously developed for other nations. The model uses population, smoking rates, and tobacco control policy data for Finland. It assesses, individually, and in combination, the effect of seven types of policies: taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth access policies. RESULTS With a comprehensive set of policies, smoking prevalence can be decreased by as much as 15% in the first few years, increasing to 29% by 20 years and 34% by 30 years. By 2040, 1300 deaths can be averted in that year alone with the stronger set of policies. Without effective tobacco control policies, 23,000 additional lives will be lost due to smoking over all years through 2040. CONCLUSIONS The model shows that significant inroads to reducing smoking prevalence and premature mortality can be achieved through tax increases, a high-intensity media campaign complete with programmes to encourage cessation, a comprehensive cessation treatment programme, stronger health warnings, and enforcement of youth access laws. Other policies will be needed to further reduce tobacco use.
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Affiliation(s)
- David T Levy
- Cancer Control, Lombardi Comprehensive Cancer Centre, Georgetown University, Washington, DC, USA
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Levy DT, Currie L, Clancy L. Tobacco control policy in the UK: blueprint for the rest of Europe? Eur J Public Health 2012; 23:201-6. [PMID: 22826505 DOI: 10.1093/eurpub/cks090] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION With male smoking prevalence at ~30% in 1998, the UK implemented stricter tobacco control policies, including a comprehensive cessation treatment programme. We evaluate their effect. METHODS Data for the UK (excluding Northern Ireland) are applied to 'SimSmoke', a simulation model used to examine the effect of tobacco control policies over time on smoking initiation and cessation. Upon validating the model against smoking prevalence, the model is used to distinguish the effect of policies implemented between 1998 and 2009 on smoking prevalence. Using standard attribution methods, the model estimates lives saved as a result of policies. RESULTS The model predicts smoking prevalence accurately between 1998 and 2009. A relative reduction of 23% in smoking rates over that period is attributed to tobacco control policies, mainly tax increases, smoke-free air laws, advertising restrictions and cessation treatment programmes. The model estimates that 210 000 deaths will be averted by the year 2040, as a consequence of policies implemented between 1998 and 2010. CONCLUSIONS The results document the UK's success in reducing smoking prevalence and prolonging lives, thereby providing an example for other European nations. When Framework Convention for Tobacco Control- (FCTC) consistent policies are also implemented, the model projects that smoking prevalence will fall by another 28% with an additional 168,000 deaths averted by 2040.
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Affiliation(s)
- David T Levy
- Cancer Control, Lombardi Comprehensive Cancer Centre, Georgetown University, WA 20007, USA
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